2015 AAHA/AAFP Pain Management Guidelines for Dogs and Cats.

The robust advances in pain management for companion animals underlie the decision of AAHA and AAFP to expand on the information provided in the 2007 AAHA/AAFP Pain Management Guidelines for Dogs and Cats . The 2015 guidelines summarize and offer a discriminating review of much of this new knowledge. Pain management is central to veterinary practice, alleviating pain, improving patient outcomes, and enhancing both quality of life and the veterinarian-client-patient relationship. The management of pain requires a continuum of care that includes anticipation, early intervention, and evaluation of response on an individual-patient basis. The guidelines include both pharmacologic and nonpharmacologic modalities to manage pain; they are evidence-based insofar as possible and otherwise represent a consensus of expert opinion. Behavioral changes are currently the principal indicator of pain and its course of improvement or progression, and the basis for recently validated pain scores. A team-oriented approach, including the owner, is essential for maximizing the recognition, prevention, and treatment of pain in animals. Postsurgical pain is eminently predictable but a strong body of evidence exists supporting strategies to mitigate adaptive as well as maladaptive forms. Degenerative joint disease is one of the most significant and under-diagnosed diseases of cats and dogs. Degenerative joint disease is ubiquitous, found in pets of all ages, and inevitably progresses over time; evidence-based strategies for management are established in dogs, and emerging in cats. These guidelines support veterinarians in incorporating pain management into practice, improving patient care.

Effects of maropitant, acepromazine, and electroacupuncture on vomiting associated with administration of morphine in dogs.

OBJECTIVE: To evaluate effects of maropitant, acepromazine, and electroacupuncture on morphine-related signs of nausea and vomiting in dogs and assess sedative effects of the treatments. DESIGN: Randomized controlled clinical trial. ANIMALS: 222 dogs. PROCEDURES: Dogs received 1 of 6 treatments: injection of saline (0.9% NaCl) solution, maropitant citrate, or acepromazine maleate or electroacupuncture treatment at 1 acupoint, 5 acupoints, or a sham acupoint. Morphine was administered after 20 minutes of electroacupuncture treatment or 20 minutes after injectable treatment. Vomiting and retching events and signs of nausea and sedation were recorded. RESULTS: Incidence of vomiting and retching was significantly lower in the maropitant (14/37 [37.8%]) group than in the saline solution (28/37 [75.7%]) and sham-acupoint electroacupuncture (32/37 [86.5%]) groups. The number of vomiting and retching events in the maropitant (21), acepromazine (38), 1-acupoint (35), and 5-acupoint (34) groups was significantly lower than in the saline solution (88) and sham-acupoint electroacupuncture (109) groups. Incidence of signs of nausea was significantly lower in the acepromazine group (3/37 [8.1%]) than in the sham-acupoint group (15/37 [40.5%]). Mean nausea scores for the saline solution, maropitant, and sham-acupoint electroacupuncture groups increased significantly after morphine administration, whereas those for the acepromazine, 1-acupoint electroacupuncture, and 5-acupoint electroacupuncture groups did not. Mean sedation scores after morphine administration were significantly higher in dogs that received acepromazine than in dogs that received saline solution, maropitant, and sham-acupoint electroacupuncture treatment. CONCLUSIONS AND CLINICAL RELEVANCE: Maropitant treatment was associated with a lower incidence of vomiting and retching, compared with control treatments, and acepromazine and electroacupuncture appeared to prevent an increase in severity of nausea following morphine administration in dogs.

The effects of low-level laser therapy in a rat model of intestinal ischemia-reperfusion injury.

BACKGROUND AND OBJECTIVE: To investigate the effects of low-level laser therapy applied to the serosal surface of the rat jejunum following ischemia and reperfusion. MATERIALS AND METHODS: Ninety-six male Sprague-Dawley rats were assigned to 15 groups and anesthetized. Small intestinal ischemia was induced by clamping the superior mesenteric artery for 60 minutes. A laser diode (70 mW, 650 nm) was applied to the serosal surface of the jejunum at a dose of 0.5 J/cm(2) either immediately before or following initiation of reperfusion. Animals were maintained under anesthesia and sacrificed at 0, 1, and 6 hours following reperfusion. Intestinal, lung, and liver samples were evaluated histologically. RESULTS: Intestinal injury was significantly worse (P < 0.0001) in animals treated with laser and no ischemia-reperfusion injury (IRI) compared to sham. Intestinal injury was significantly worse in animals that underwent IRI and laser treatment at all time points compared to sham (P < 0.001). In animals that underwent IRI, those treated with laser had significantly worse intestinal injury compared to those that did not have laser treatment at 0 (P = 0.0104) and 1 (P = 0.0015) hour of reperfusion. After 6 hours of reperfusion there was no significant difference in injury between these two groups. Lung injury was significantly decreased following IRI in laser-treatment groups (P < 0.001). CONCLUSIONS: At the dose and parameters used, low-level laser did not protect against intestinal IRI in the acute phase of injury. However, laser did provide protection against distant organ injury. Failure to observe a therapeutic response in the intestine may be due to inappropriate dosing parameters. Furthermore, the model was designed to detect the histologic response within the first 6 hours of injury, whereas the beneficial effects of laser, if they occur, may not be observed until the later phases of healing. The finding of secondary organ protection is important, as lung injury following IRI is a significant source of morbidity and mortality.

Managing pain in feline patients.

This article reviews the current knowledge of pain assessment in cats and the most effective methods for its alleviation. Excellent acute pain management is achievable in cats by using opioids, nonsteroidal anti-inflammatory drugs (NSAIDs), alpha(2)-agonists, and local anesthetics. A multimodal approach using agents that work at different places in the pain pathway is encouraged because this can have added benefits. Management of chronic pain in cats can be challenging, but there is now an approved NSAID for long-term use. As we gain experience with less traditional analgesics, such as gabapentin, and critically evaluate complimentary therapies, our ability to provide comfort to this population of cats should improve.

Standing sedation and pain management for ophthalmic patients.

Several ocular procedures, including examination, removal of corneal foreign bodies, nictitans surgery, eyelid repair, and tumor excision,can be successfully performed in the appropriately restrained and sedated standing horse. Sedation is best achieved with xylazine,with or without the addition of acepromazine. Additional analgesia can be provided with appropriate local anesthetic blocks. Surgical conditions are greatly improved by using an auriculopalpebral and supraorbital block and topical anesthetics. More elaborate standing sedation involving continuous rate infusions of lidocaine or detomidine combined with butorphanol may facilitate more involved surgery with appropriate support staff and equipment in animals that are at high risk for general anesthesia or when the latter is not an option. Short-term or long-term analgesia is most commonly provided with nonsteroidal anti-inflammatory drugs, but several newer techniques, including lidocaine and butorphanol infusions, may be effective. Topical treatment with opioids to provide analgesia and opioid antagonists to enhance corneal healing is an exciting new development that may revolutionize our approach to corneal ulcer therapy in the future if current research findings are supportive.